痛みの神経生理学的機構に基づく理学療法の重要性

総説Review articles　日本人の多くが痛みを経験するが，現代のリハビリテーション医療では，治療効果が得られにくい患者もおり，症状の慢性化に至る例も少なくない．慢性疼痛の原因は，痛みを長期間，頻回に受けることにより，痛みの神経生理学的機構における中枢神経系の可塑的変化が生じることにより起きている．痛み治療において，集学的アプローチが重要であり，医師の薬物治療は，痛みの神経生理学的機構に基づいて行われて，効果を発揮している．本稿では，現在解明されている痛みの神経生理学的機構とその破綻による慢性疼痛のメカニズムについて概要し，痛みの神経生理学的機構に基づいた理学療法の重要性について，論述した．　A large number of Japanese people have experienced pain, however modern rehabilitation treatment is less likely to treat their pain completely, and the pain may lead to chronic symptoms. A primary cause of chronic pain is the mechanism of occurrence of plastic changes in the central neuro system. The neurophysiological plastic change results from repeated pain in a long period. As to pain therapy, a multimodal approach is essential for the therapeutic effect and physician’s medication based on the neurophysiological mechanism of pain makes more effective results rather than the modern medical treatment. In this article, we expounded the outline of neurophysiological mechanism of pain and the existing problem of mechanism of chronic pain. Finally, we discussed the importance of the current physical therapy based on the neurophysiological mechanism of pain

せん妄の早期発見・予防と理学療法の重要性

総説Review articles　せん妄は急性期病院だけでなく医療現場全体に渡る問題である．せん妄の発症はADL やQOL の低下に関連するだけでなく，生命予後の独立不良因子である．せん妄は早期発見と予防が重要であるが，現状では正確にせん妄を評価することができておらず見逃されることが多い．せん妄と評価される手前の閾値下せん妄は，症状の出現が分かりづらく，発見が遅れるといった問題がある．せん妄の発症メカニズムは脳内ネットワークの障害があり，理学療法評価・治療によりせん妄の早期発見・予防ができる可能性がある．せん妄を症状のみから捉えるのではなく，発症メカニズムに基づいて脳の反応から捉えることが必要である．本稿では，せん妄発症による問題点と，発症メカニズムの仮説から理学療法がせん妄の早期発見・予防にとって重要であることを，早期発見ツール・発症予防プログラムの開発の観点から論じる．　Delirium, a common clinical problem in hospitalized individuals, has been found to be a strong independent prognostic factor in critically ill patients, with a large effect on the impairment of their activities of daily living and quality of life. Early diagnosis and prevention are important strategies for delirium; however, it is often not diagnosed accurately. Subsyndromal delirium is difficult to evaluate clinically. Evaluating the dysfunction and restriction of the brain network, which is thought to be the cause of delirium, may provide new strategies for its prevention. We discuss the properties of a tool for the screening and early diagnosis of delirium based on the discontinuation and restriction of the brain network. Furthermore, we focus on the importance of physiotherapy as a new treatment strategy for delirium

Observation results by the TAMA300 detector on gravitational wave bursts from stellar-core collapses

We present data-analysis schemes and results of observations with the TAMA300 gravitational-wave detector, targeting burst signals from stellar-core collapse events. In analyses for burst gravitational waves, the detection and fake-reduction schemes are different from well-investigated ones for a chirp-wave analysis, because precise waveform templates are not available. We used an excess-power filter for the extraction of gravitational-wave candidates, and developed two methods for the reduction of fake events caused by non-stationary noises of the detector. These analysis schemes were applied to real data from the TAMA300 interferometric gravitational wave detector. As a result, fake events were reduced by a factor of about 1000 in the best cases. The resultant event candidates were interpreted from an astronomical viewpoint. We set an upper limit of 2.2x10^3 events/sec on the burst gravitational-wave event rate in our Galaxy with a confidence level of 90%. This work sets a milestone and prospects on the search for burst gravitational waves, by establishing an analysis scheme for the observation data from an interferometric gravitational wave detector

Clinical early phase II study of bicalutamide (Casodex) in patients with prostatic cancer

ビカルタミド1日1回50mg群, 80mg及び100mgを12週間投与する3群比較の無作為化非盲検試験を実施した. 1)登録症例は124例で, 適格例は122例であった. 2)総合効果における奏効率は50mg群, 80mg群及び100mg群でそれぞれ50.5%, 61.0%及び53.7%であった. 3)PSAに対する奏効率は50mg群, 80mg群及び100mg群でそれぞれ84.2%, 92.7%及び97.6%であった. 4)副作用発現率は3群ほぼ6割で副作用による中止例は80mg群の1例のみで, 安全度において3群間に有意差はなかった.主な副作用は乳房腫脹, 乳房圧痛等であったTo investigate the efficacy and safety of bicalutamide (Casodex(R)) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks ; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40); 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 ing group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily

CLINICAL EVALUATION OF TSAA-291 IN TREATMENT OF BENIGN PROSTATIC HYPERPLASIA BY DOUBLE BLIND STUDY

In order to evaluate the clinical effects of TSAA-291 in patients diagnosed as benign prostatic hyperplasia, a double blind controlled study was carried out incorporating the departments of urology at 53 hospitals. Four hundred mg (H: high dose group) or 40 mg (L: low dose group, control) of TSAA-291 was injected intramuscularly once a week for 12 weeks to 312 patients in addition to daily dose of 6 capsules of Paraprost. For the last 4 weeks, between 12th and 16th week, Paraprost only was administered. 1) The therapeutic effects were investigated in 236 patients (H: 123, L: 113), 76 being deleted for various reasons. There was no bias in the background features of the two groups. 2) Global improvement rates, evaluated by scoring dysuria, sensation of urinary retention, nycturia, residual urine volume, palpation and urethrocystogram, demonstrated that H was significantly superior to L (p<0.05-0.01). 3) General improvement rates evaluated by the attended doctors, demonstrated H to be superior to L (rank sum test, p<0.10), with marked improvement in 12 patients (11.4%) ofH but none in L. 4) Concerning dysuria, H was superior to L, especially, the difference between the two groups in "protracted urination" and that in "force of urinary stream" were pronounced (p<0.05, p<0.01). 5) The rate of patients whose residual urine volume decreased remarkably was significantly higher in H than in Lfrom4th to 16th week (p<0.05). On palpation predominance of H gradually became clear but the difference between the two groups was not significant. 6) Improvement on urethrocystograms were evaluated by 4 judges. H was generally superior to L (rank sum test, p<0.10) and the rate of improvement of H (36.0%) was higher than that of L (21.8%). 7) Analysis by stratification (age, duration of illness, severity at initiation of medication) revealed no particular trend in global evaluations. 8) Side effects were found in 17 patients of H (11.3%) and 7 patients of L(4.6%) and the frequency was higher in H (p<0.10), but they were mostly related to the symptoms at the injection site, such as pain. These symptoms disappeared during medication or within a week after the final administration. None of severe side effects were found. 9) Red blood cells, hemoglobin and hematocrit decreased slightly but these changes were judged reversible since they returned to the previous levels 5 weeks after the final administrations. 10) Blood pressure in 124 patients, ECG in 50 patients and hormones in blood, LH, FSH, cortisol and testosterone in 26 patients, were analyzed. No significant changes were observed and there were no differences between the two groups. 11) On the basis of these results, it is advocated that TSAA-291 could be a useful tool in nonsurgical treatment of benign prostatic hyperplasia